19 C.F.R. § 141.85
A pro forma invoice submitted in accordance with any provision of this chapter shall be in substantially the following form:
Pro Forma Invoice
Importers Statement Of Value Or The Price Paid In The Form Of An Invoice
Not being in possession of a commercial seller's or shipper's invoice I request that you accept the statement of value or the price paid in the form of an invoice submitted below:
Name of shipper
address ________________________
Name of seller
address ________________________;.
Name of consignee
address ________________________.
Name of purchaser
address ________________________.
The merchandise (has) (has not) been purchased or agreed to be purchased by me.
The prices, or in the case of consigned goods the values, given below are true and correct to the best of my knowledge and belief, and are based upon: (Check basis with an "X")
| A-Case marks numbers | B-Manufacturer's item No. symbol or brand | C-Quantities and full description | D-Unit purchase price (currency) | E-Total purchase price (currency) | F-Unit foreign value | G-Total foreign value |
Check which of the charges below are, and which are not included in the prices listed in columns "D" and "E":
| Amount | Included | Not included |
| Packing | ||
| Cartage | ||
| Inlandfreight | ||
| Wharfage and loading abroad | ||
| Lighterage | ||
| Ocean freight | ||
| U.S. duties | ||
| Other charges (identify by name and amount) | ||
| Total |
Country of origin ________________________.
If any other invoice is received, I will immediately file it with an authorized CBP official.
(Signature of person
making invoice)
(Title and firm name)
Date
19 C.F.R. §141.85